Entries Tagged 'HFMD' ↓

What is HFMD?

Hand-foot-and-mouth disease (HFMD) is an acute viral illness that presents as a vesicular eruption in the mouth. HFMD can also involve the hands, feet, buttocks, and/or genitalia.

Viruses

• Coxsackievirus A type 16 (CV A16) is the etiologic agent involved in most cases of HFMD
• The illness is also associated with coxsackievirus A5, A7, A9, A10, B2, and B5 strains,
• Enterovirus 71 (EV-71)
• HFMD epidemics associated with EV-71 have been more common in south East Asian countries

Children younger than 10 years are most commonly affected.

• Initially, macular lesions appear on the buccal mucosa, tongue, and/or hard palate.
• These mucosal lesions rapidly progress to vesicles that erode and become surrounded by an erythematous halo.

Skin lesions, which present as tender macules or vesicles on an erythematous base, develop in approximately 75% of patients with hand-foot-and-mouth disease (HFMD).

• A fever of 38-39°C may be present for 24-48 hours.
  HFMD caused by coxsackievirus strains rarely presents with concomitant aseptic meningitis.
  • HFMD caused by EV-71 has a higher incidence of neurologic involvement, including a poliolike syndrome, aseptic meningitis, encephalitis, encephalomyelitis, acute cerebellar ataxia, acute transverse myelitis, Guillain-Barré syndrome, opsomyoclonus syndrome, and benign intracranial hypertension.
  • HFMD caused by coxsackievirus is generally a mild self-limited illness that resolves in 7-10 days; rarely, HFMD may recur or persist. Serious complications are also rare.

  Severe oral ulcerations can create painful stomatitis. This may interfere with oral intake and cause dehydration, the most common complication of HFMD. Rarely, aseptic meningitis accompanies coxsackievirus-induced HFMD

Atypical clinical features

How does HFMD spread

Infection generally occurs via the fecal-oral route or via contact with skin lesions and oral secretions Viremia develops, followed by invasion of the skin and mucous membranes. Widespread apoptosis likely results in the characteristic lesion formation.

Complications

HFMD-Coxakie
• HFMD caused by coxsackievirus is generally a mild self-limited illness that resolves in 7-10 days; rarely, HFMD may recur or persist. Serious complications are also rare.
• Severe oral ulcerations can create painful stomatitis. This may interfere with oral intake and cause dehydration, the most common complication of HFMD. Rarely, aseptic meningitis accompanies coxsackievirus-induced HFMD

HFMD -EV71

HFMD caused by EV-71 has a higher incidence of neurologic involvement,
Poliolike syndrome, aseptic meningitis, encephalitis, encephalomyelitis, acute cerebellar ataxia, acute transverse myelitis, Guillain-Barré syndrome, opsomyoclonus syndrome, and benign intracranial hypertension. These neurological complications have been attributed to either immunopathology or virus-induced damage to gray matter.

• cardiopulmonary complications such as myocarditis, interstitial pneumonitis, and pulmonary edema may occur. Neurologic involvement with sequelae is less likely to occur in patients with HFMD caused by coxsackievirus strains than with HFMD caused by EV-71.

Diagnosis of hand-foot-and-mouth disease (HFMD)

Diagnosis of hand-foot-and-mouth disease (HFMD) is typically based on clinical grounds. Laboratory studies are usually unnecessary

• • The treatment of hand-foot-and-mouth disease (HFMD) is supportive.
  • Ensure adequate fluid intake to prevent dehydration.
  • Intravenous hydration may be necessary if the patient has moderate-to-severe dehydration.
  • Fever may be treated with antipyretics(Acetaminophen).
  • Pain may be treated with standard doses of acetaminophen or ibuprofen.
  • Direct analgesia may also be applied to the oral cavity via mouthwashes or sprays.